Milliman model analyzes COVID-19 recession and healthcare coverage in the United States

The COVID-19 pandemic and the mitigating actions in response by citizens and governments alike have precipitated unprecedented economic disruption in the United States. The second quarter of 2020 marked the largest single-quarter economic contraction in modern U.S. history, driving unemployment rates from historically low levels in February to peaks last seen during the Great Depression.

The unraveling and recovery of the U.S. economy have had and will continue to have a similarly disruptive influence on the enrollment in and composition of U.S. health insurance markets. These impacts will be felt throughout the health system, including in state Medicaid budgets and hospital, physician, and pharmaceutical margins, as well as in the financial performance of commercial and Medicaid health plans.

To understand the interconnected nature of economic changes and health insurance coverage and to project impacts to U.S. health insurance markets, Milliman built a tool referred to as the COVID-19 Advanced Population Shift model. This model combines detailed information on the economic status, health insurance coverage, and health status of each state’s population prior to the COVID-19 pandemic with emerging information on the economic impact of the pandemic response. It allows forecasting the resulting shifts in enrollment and population morbidity across the healthcare markets while providing insight into the key factors driving change. Milliman’s Fritz Busch, Lindsy Kotecki, and Jeff Milton-Hall summarize the findings in this paper.

Pharmacy Briefing: October 2020

Pharmacy Briefing is a monthly summary of select U.S. Food and Drug Administration (FDA) approvals and launches, treatment guidelines and research updates, and other newsworthy events that have the potential to impact commercial drug utilization or costs.

  • President Trump signs executive order on “most-favored-nation” drug prices
  • U.S. Department of Health and Human Services (HHS) issues final rule on plan for Canadian drug importation
  • OptumRx announces annual formulary updates
  • CVS Health announces annual formulary updates
  • Generic versions of HIV drugs Truvada (emtricitabine/tenofovir disoproxil) and Atripla (efavirenz/emtricitabine/tenofovir disoproxil) are launched
  • Meta-analysis finds decreased COVID-19 mortality rate associated with corticosteroid treatment
FDA Approvals and Launches
  • Generic versions of HIV drugs Truvada (emtricitabine/tenofovir disoproxil) and Atripla (efavirenz/emtricitabine/tenofovir disoproxil) are launched.
  • Generic versions of multiple sclerosis drug Tecfidera (dimethyl fumarate) are launched.
  • Mylan launches long-acting insulin Semglee (insulin glargine) as an alternative to Lantus (insulin glargine).
    • The two products are not currently interchangeable.
  • Winlevi (clascoterone cream), a first in-class androgen inhibitor, is approved to treat acne.
  • Trelegy (fluticasone furoate/umeclidinium/vilanterol) receives additional approval as a maintenance treatment for asthma.
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Potential impact of COVID-19 on continuing care retirement community mortality and morbidity

The health and long-term care industries, including continuing care retirement communities (CCRCs), were among those most directly and adversely affected by the COVID-19 pandemic.

From the early stages of the pandemic, it was apparent that COVID-19 exerted a disproportionate impact on elderly individuals, residents of nursing homes, and those with certain preexisting health conditions. These demographics overlap significantly with the CCRC population, making the COVID-19 pandemic an especially challenging and uncertain time for CCRCs.

In this article, Milliman’s Andrew Dalton and Gregory Zebolsky discuss the impact that COVID-19 could have on actuarial assumptions relevant to CCRCs. They also develop and present representative population flow projections for a hypothetical community with three levels of care, focusing on how the pandemic may change experience over the next several years relative to pre-pandemic expectations.

Treating behavioral health conditions through telehealth is becoming the “new normal”

The COVID-19 pandemic has created significant mental health challenges for many around the world, both directly due to the consequences of the disease, and indirectly due to the difficult circumstances that arise from mitigation strategies.

During the pandemic, the gap in care for mental illnesses and substance use disorders has been magnified by the reduction in face-to-face office visits for treatment resulting from restrictions on elective care visits, physical distancing guidelines, and the fear of spreading or contracting the disease. This challenge is being addressed by some insurers and providers through rapidly increasing use of telehealth tools to provide treatment for mental illnesses and substance use disorders.

In this article, Milliman’s Steve Melek, Stoddard Davenport, and Travis Gray explain why telehealth visits may become part of the “new normal” for replacing, or at least supplementing, office visit-based treatment for behavioral health conditions.

How has COVID-19 affected home and community-based services in the U.S.?

Millions of Americans with chronic or disabling conditions rely on home and community-based services (HCBS) to meet daily self-care and independent living needs. These services enable participants to remain safely in their homes and communities rather than moving to a nursing home or other institutional setting. State Medicaid programs are the largest payer for HCBS across the United States. The COVID-19 pandemic has presented numerous challenges and had a significant impact on the provision of HCBS.

In this paper, Milliman’s Jill Herbold and Nick Johnson discuss some challenges faced, actions taken, and the impact that the COVID-19 pandemic may have on HCBS for years to come.

A look into the future of long-term care insurance

Funding for long-term care (LTC) benefits may change in the future given the increasing LTC needs of the baby-boom generation and the recent attention that has been given to affordable LTC services.

The United States may not be prepared to transition to a “complete” social LTC program, but it’s possible that an involuntary, partial social program could be established to provide LTC coverage.

In this article, Milliman’s Stephanie Moench discusses a scenario in which funding for LTC services would reflect aspects of the status quo and the “Medicare for All”/”single-payer” system.